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Articles

Iron deficiency: the global perspective.

Author

Cook JD, Skikne BS, Baynes RD

Date

1994

Journal

Adv Exp Med Biol

Abstract

The prevelance of IDA in industrialized countries has declined in
recent decades, but there has been little change in the worldwide
prevalence. IDA is currently estimated to affect more than 500
million people. Recent studies have indicated that anemia per se, the
most common manifestation of iron deficiency, is less important from
a public health standpoint than liabilities associated with tissue
iron deficiency. The most important of the latter are an impairment
in psychomotor development and cognitive function in infants and
preschoolers, a deficit in work performance in adults, and an
increase in the frequency of low birth weight, prematurity, and
perinatal mortality in pregnancy. There have been several recent
advances in combatting nutritional iron deficiency. One of the major
problems has been in distinguishing iron deficiency from other causes
of anemia seen epidemiologically such as malaria, HIV infection,
chronic inflammation, hemoglobinopathies, and protein energy
malnutrition. When combined with serum ferritin and hemoglobin
determinations, the serum transferrin receptor assay is a valuable
addition in epidemiologic surveys because it provides a quantitative
measure of functional iron deficiency and it distinguishes true IDA
from the anemia of chronic disease. The most difficult challenge is
to develop effective methods of supplying iron to large segments of a
population. Supplementation with iron tablets is suitable for only
brief periods of need such as during pregnancy. The poor compliance
with existing supplementation programs is believed to be due mainly
to the gastrointestinal side effects of oral iron which can be
eliminated by the use of a gastric delivery system. The most
effective long-term strategy is to increase the intake of
bioavailable iron in the diet. The customary approach has been to
fortify a food staple such as wheat, rice, sugar, or salt, and
thereby increase the iron intake of the entire population. However,
because of concerns about the risk of cancer and heart disease in
individuals with high iron stores, there is an increasing reluctance
to supply iron to individuals who do not require it. A more effective
strategy is to fortify food vehicles that are targeted to segments of
the population at greatest risk of iron deficiency such as infants
and school children. Because of the strong inhibitory properties of
diets in regions of the world where iron deficiency is most
prevalent, the use of NaFeEDTA has important advantages for food
fortification.